Northeast Joco

October 29, 2013

Johnson County Commission looks to stem red ink from mental health center

$1 million is needed to meet payroll obligations through the end of the year.

The Johnson County Mental Health Center has lost money steadily for the past five years and is now in a financial crisis so dire that the Johnson County Commission will have to bail it out to the tune of about $1 million so the department can meet its payroll until the end of the year.

The state of affairs is such that some commissioners proposed the county manager’s office take more day-to-day control of financial decisions that are now made by the center’s director and the Mental Health Governing Board.

Meanwhile, the mental health center’s director, Maureen Womack, is on administrative leave. Chad VonAhnen, executive director of Johnson County Developmental Supports, has been appointed to oversee the center for the next 90 days.

The county commission will step in and fix the problem in the short term, with a transfer from its general fund to cover the rest of the year, said Chairman Ed Eilert. After that, “there needs to be more intervention in the financial area” of the center’s operations, he said.

Commissioner Michael Ashcraft said the budget problems should not have any impact on services. “The core issue is we are going to be providing service to the people of Johnson County who need it,” he said.

The mental health center has been steadily leaking money since at least 2009, according to figures from the county budget office. In only one of the past five years has the center’s revenue been higher than what it spends.

County officials cited a variety of reasons for the shortfall.

The center takes in money from taxes, federal and state grants and “fees for services.” The fees for services come from mental health clients and billings to their insurance companies.

The tax and grant money have stayed relatively stable over the years, while the cost of providing service has increased, and that amounts to part of the reason for the financial problems, said Scott Neufeld, county budget director.

But a far bigger problem has been brewing in the fees for services area. In 2011, fees amounted to $12.4 million of the center’s $30.6 million in actual revenue. But this year, the fees are projected to bring in only $8.7 million of $26.5 million revenue. That is a drop not only in dollars but also in percentage of revenues.

As a result, the center has been spending down its cash fund. In better days, the cash cushion was about $3.1 million, Neufeld said. At the end of 2009, it was $2.8 million. By the end of 2012, the cash fund was down to $900,000 and this year it will be in deficit territory of about $900,000.

Fees for services are generated by clinicians and case workers who can bill for the hours they spend seeing clients and helping them live in the community. But county figures also show the department has been losing those employees about as fast as it has been losing money.

Mental health has lost over a quarter of its billing employees over the last year, from 249 in 2009 to 183 this year. Fifty-two of those 66 employees left during the past two years.

None of the departures was due to layoffs. Tim DeWeese, clinical director of the mental health center, said there is usually a somewhat higher turnover in that line of work than in other jobs. He also pointed out that the inception of KanCare, the state’s new managed care system to provide medical care for the poor and disabled, has taken its toll on his work force, as the managed care agencies in Johnson County started looking for good employees.

Maury Thompson, assistant county manager, also said some loss could be attributed to employees taking the county’s voluntary retirement incentive that was initiated to cut back on the county workforce during the recent recession.

In any case, the loss of caseworkers and clinicians has meant bigger caseloads and overtime for the ones remaining, DeWeese said. The result is that there has been a decrease in the number of people served and that employees have less time to spend on each case.

The county mental health department works with people who have what are considered serious and debilitating mental illness, such as schizophrenia, bipolar disorder and severe depression, DeWeese said. Caseworkers help patients navigate an array of services so they can live in the community.

The department charges these patients on a sliding scale based on need. Some are at least partially covered by insurance. But a large portion of county clients are so poor they are not charged or charged only minimally.

“A majority of the people we serve are considered in poverty,” he said. About 44 percent earn less than $10,000 a year.

The county commission and mental health administrators have been at odds since spring about the direction of the department and about the fact that the department still had 76 unfilled employee positions on the books.

Having unfilled positions on the books can justify a higher budget, with the assumption that when things get better, more employees will be hired, Thompson said in explaining why a department would keep open positions in a budget.

The county commission has been trying to sweep those ghost positions off the books, said Eilert. Last spring, as county officials prepared for the 2014 budget, it became clear that the situation at the mental health department budget had deteriorated, he said. The commission asked mental health to reduce its projected expenditures and revenue, which had been based on the 76 unfilled positions.

That came to a head during the August meeting where the commission made its budget final. The commission had ordered mental health to cut its budget, but the department had not. Mental health board members Cindy Neighbor and Stuart Conrad went before the commission and argued that county staffers had told them to essentially come up with a budget that was based on false revenue assumptions.

The commission then voted to reduce the department’s budget by $5.4 million.

Commissioners are still looking at how the department’s finances should be run, but Eilert said he expects the mental health governing board would continue as it is. The county manager’s office may become more directly involved in the center’s finances, however.

Meanwhile, questions remain about the status of Womack, the center’s executive director. Most of the billing caseworkers left the department during her tenure. Womack replaced former director David Wiebe, who ran the department for 26 years. But county officials were unwilling to comment on whether the exodus was directly related to Womack or whether she would be asked to resign.

Womack did not respond to requests for comment.

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